AccountId: 011433970860
ContactId: 4efeac7b-5759-4eb4-b752-87bebbdb6809
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 647700 ms
Total Talk Time (AGENT): 282255 ms
Total Talk Time (CUSTOMER): 120026 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/4efeac7b-5759-4eb4-b752-87bebbdb6809_20250311T15:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling for the provider Emory clinic.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] I'd like to get status on a medical claim please.
[AGENT][NEUTRAL] OK, um, I believe we were just talking, it was for [PII].
[CUSTOMER][NEUTRAL] Yeah, it was, it sure was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so let me, hold on, let me, um, pull it back up for you. Hold on one second. Oh, no, you're fine.
[CUSTOMER][NEUTRAL] I'm sorry about that. My phone just cut off on you.
[AGENT][NEUTRAL] You are totally fine. Hold on one moment. OK. So for the $702 well, since it's a new call, all the information provided is a verification of benefits, not a guarantee of payment. You don't have to verify because we literally just did it. Um, so the You're welcome. The $702 we received two, you said there were two different providers. They were both received on [PII].
[CUSTOMER][POSITIVE] OK, I appreciate it.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the, so it says the Emory Clinic, it doesn't list the provider, so I can give you the procedure code because it's a different procedure code.
[AGENT][NEUTRAL] So you know which one is which?
[CUSTOMER][NEUTRAL] 00812.
[AGENT][NEUTRAL] OK, so that one, the claim number is 356.
[AGENT][NEUTRAL] 4030.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And on [PII], um, it was denied because um the policy does not provide an anesthesia benefit.
[CUSTOMER][NEGATIVE] Not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And the
[CUSTOMER][NEUTRAL] Next one for.
[AGENT][NEUTRAL] So the next one, received on the same day, processed on the same day. The claim number is 356.
[AGENT][NEUTRAL] 4033.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, um, hold on, did I flip those?
[AGENT][NEUTRAL] Hold on. The 4033 is the um anesthesia benefit.
[AGENT][NEUTRAL] Um, so that's the one that doesn't have the, Why is this coming over like this? Hold on one second.
[AGENT][NEUTRAL] OK, yeah, the other one is 88305. OK.
[AGENT][NEUTRAL] So the um the claim number ending in 356-4033 is for the anesthesia benefit which was denied because um anesthesia is not covered on the policy. The other um code 88305 is claim number 3564035.
[CUSTOMER][NEUTRAL] OK, that's a different claim number you gave me.
[AGENT][NEUTRAL] It's 2 claim numbers.
[CUSTOMER][NEUTRAL] OK, you gave me 356-403-0.
[AGENT][NEUTRAL] 4030 on what? OK, so my apologies, it ends in a 5.
[CUSTOMER][NEUTRAL] OK, 5, OK, got it.
[AGENT][NEGATIVE] And this one was um denied due to it's not a covered loss on the plan.
[AGENT][NEGATIVE] No amount payable for this expense.
[CUSTOMER][NEUTRAL] OK, I'm trying to figure out how because both I'm looking at both those claims and they both have the same.
[CUSTOMER][NEUTRAL] Cause the anesthesiology.
[AGENT][NEUTRAL] Hold on, I went back in and out. Say that one more time.
[CUSTOMER][NEUTRAL] I said both of those charges $702.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They're both for anesthesiology.
[AGENT][NEUTRAL] But it's two different codes.
[CUSTOMER][NEUTRAL] So you
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're saying it's two different codes.
[AGENT][NEUTRAL] Yes, so like the, the one ending in 4033 has a code, a procedure code of 00812.
[CUSTOMER][NEUTRAL] Because um
[CUSTOMER][NEUTRAL] Right, mhm.
[AGENT][NEUTRAL] The other claim has a code of
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Oh, wait a minute. There are multiple, hold on one second.
[AGENT][NEUTRAL] There's a claim that was received in between the claims and they're all Emory. Hold on one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I was correct. So the two claims that are for the 00812 is 356-4030.
[CUSTOMER][NEUTRAL] OK, no 5 at the end?
[AGENT][NEUTRAL] The 5 is in between these two.
[CUSTOMER][NEUTRAL] OK, so I get rid of that.
[AGENT][NEUTRAL] It's a, it's a different code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the other one is the 356-403-3.
[CUSTOMER][NEUTRAL] Right, got it.
[AGENT][NEUTRAL] So they were both received on the [PII], processed on the [PII], and they both have the same. You can um
[AGENT][NEGATIVE] Not covered under this plan, you can disregard that one. Anesthesia is not um a benefit on this policy. Mhm.
[CUSTOMER][NEGATIVE] Not covered under the policy.
[CUSTOMER][NEUTRAL] Cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I have one more for this patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] for $533.33.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Alright, and TJ, do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Oh, no problem, sure.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] All right. You are on hold.
[AGENT][NEGATIVE] This is so annoying.
[AGENT][NEUTRAL] 310, 3:49 because HI doesn't show the total bill so you're gonna have to figure it out yourself.
[AGENT][NEUTRAL] 355-5366.
[AGENT][NEUTRAL] This got a million lines.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] What did you say 5 3333?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes I'm here mhm.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, so the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3555366.
[AGENT][NEUTRAL] And on [PII], um, the claim was denied. There's uh several different reasons depending on the code, but, um, did you want me to go over each one?
[CUSTOMER][NEUTRAL] Um, can you send me that explanation of benefits? Can you fax it to me?
[AGENT][NEUTRAL] Sure, what's a good fax number for you? Mhm.
[CUSTOMER][NEUTRAL] Uh yes, that fax number.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, should I put attention DJ?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][POSITIVE] So I'm sending this over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEGATIVE] Um, maybe you could send me the other ones too that was denied since they were all denied.
[AGENT][NEUTRAL] So you need the one for the um [PII] and then the [PII]?
[CUSTOMER][NEUTRAL] On that patient.
[CUSTOMER][POSITIVE] Right, yes, appreciate it.
[CUSTOMER][NEGATIVE] Since they were all denied.
[AGENT][POSITIVE] All right, so I'm sending them to you now. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Is there a reference number for this call, [PII]?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right I appreciate it thanks for your patience you have a great day.
[AGENT][POSITIVE] You're very welcome. You also thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.